Goa Medical College

Cutaneous vasculitis involves active inflammation of blood vessels of all caliber, leading to widespread systemic involvement and morbidity. The data regarding the utility of nailfold capillaroscopy (NFC) in cutaneous vasculitis is sparse. Since NFC offers direct visualization of the affected system, the microvasculature, its role appears promising and can serve as a valuable diagnostic adjunct.

We conducted this study to evaluate various NFC changes in patients with vasculitis and correlate them with systemic involvement.

A cross-sectional study involving 22 patients with cutaneous vasculitis and 15 controls was conducted to assess NFC changes using a handheld dermatoscope over a period of one year.

NFC score, capillary dropouts, avascular areas, and receding capillaries were statistically significant NFC findings among cases ( P < 0.05). NFC findings, including dilated capillaries (66.7% vs. 50%), avascular areas (75% vs. 40%), and receding capillaries (66.7% vs. 50%), were more commonly observed in patients with renal involvement compared to those without. NFC score (77% vs. 61%), dilated capillaries (77.8% vs. 46.1%), tortuous capillaries (55.6% vs. 30.7%), receding capillaries (66.7% vs. 53.8%), and capillary dropouts (66.7% vs. 53.8%) were more frequently observed in patients with ulcerative skin lesions. Patients with comorbidities exhibited NFC score (80% vs. 58.3%), crisscross capillaries (30% vs. 16.7%), receding capillaries (80% vs. 41.7%), and avascular areas (70% vs. 58.3%) more commonly.

A small sample size and only qualitative parameters could be assessed due to the lack of a video dermoscope. The study design was not intended for follow up, and a comparison of NFC changes during the active and non-active phases could not be done.

We conclude that capillary disorganization, capillary dropouts, receding capillaries, and avascular areas were significant findings among patients with vasculitis. Also, NFC changes were more common in patients with systemic involvement, ulcerative lesions, and in patients with underlying comorbidities.

As people age, they are more likely to develop chronic diseases, experience physical and mental impairments, and face social issues. This complexity makes traditional research protocols challenging, leading to the exclusion of older individuals in clinical trials (CTs) and limiting the applicability of evidence-based medicine, especially in low- and middle-income countries (LMICs). A scoping review of the literature (based on PubMed, Embase, and Scopus) was conducted to identify recommendations to improve the methodology of CTs involving older persons. The findings were then shared with a panel of researchers with expertise in older adult research in LMICs, who assessed and refined the recommendations for implementation in low-resource settings. After screening more than 4,700 articles, 80 were retained as relevant, providing 1,119 inputs on the design and conduct of CTs in older persons. These inputs were homogenised into 120 recommendations and organised into 13 clusters representing different phases and aspects of a CT. Key recommendations, enriched from experts' input, indicate the importance of addressing various barriers that hinder older persons' participation in CTs in LMICs, such as poor funding, inadequate age-friendly facilities, ageism, transportation issues, and the need for standardised terminology and culturally sensitive assessment tools. CTs involving older individuals face unique challenges. Effective methodologies and innovative approaches are essential for generating scientific evidence that informs clinical practice and promotes healthy ageing. The present work highlights the need for practical, inclusive strategies to navigate the complexities of conducting CTs in older adults.

Capecitabine is a 5-fluorouracil precursor, approved for breast and colorectal cancer. We report a case of capecitabine-induced coronary vasospasm. A 77-year-old woman with breast cancer receiving capecitabine presented with chest pain, and an electrocardiogram demonstrated acute anterior-lateral myocardial infarction. Coronary angiography demonstrated normal coronary arteries. Discontinuation of capecitabine resolved symptoms. Failing to identify the cardiotoxicity associated with capecitabine could have had serious consequences.